Medical Claims Billing Specialist

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

*This position is a hybrid full-time role that requires in office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but subject to change for internal meetings, trainings, and conferences.*

Under the direction of the Manager of Revenue Cycle Management, the Medical Claims Specialist (AR Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The Medical Claims Specialist will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. Resolution of SalesForce cases and management of issues and the team resolving the cases is a key element in this role. 

Primary Job Duties:

• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives

• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques

• Collaborate with internal teams (Performance, Operations, Sales) as well as care center staff when appropriate

• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. 

• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality

• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals

• Other duties as assigned

Qualifications

• Education: High School diploma